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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197700177
Report Date: 05/04/2023
Date Signed: 05/04/2023 01:57:59 PM

Document Has Been Signed on 05/04/2023 01:57 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:VARDONOVA, MARINA FAMILY CHILD CAREFACILITY NUMBER:
197700177
ADMINISTRATOR:VARDONOVA, MARINAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(818) 913-1403
CITY:SUNLANDSTATE: CAZIP CODE:
91040
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: DATE:
05/04/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH:Marina Vardonova, LicenseeTIME COMPLETED:
02:10 PM
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On 05/04/23 Licensing Program Analyst (LPA) Justeene Tamayo met with Licensee, Marina Vardonova who guided analyst on a tour of the facility for the One Year Required inspection. This is a one story, 3 bedroom, 2 bathroom home with kitchen/dining, living room, laundry room and garage. There is no pool/spa or body of water on the premises. Upon arrival LPA observed 1 infant and 3 preschool child in care. Family members residing in the home include 1 adult (licensee) and no minor children. Facility operation are Monday-Friday 6:30AM-6:30PM. Incidental Medical Services (IMS) policy was discussed.

Physical Plant: Main care is provided in the living room and bedrooms #1-2. Children use the bathroom in hallway on the right. Children have access to the living room, playroom, and backyard. Off limit areas include bedroom #3, bathroom #2, laundry room (safety door knob) and garage. The home was inspected inside and out for safety, clean and orderly, comfort, cleanliness, telephone service, heating and ventilation, inaccessibility to poisons, detergents/cleaning compounds (in kitchen pantry), medicines (upper kitchen pantry) and hazardous items (sharp knives in kitchen drawer) that can pose a danger to children. LPA observed the whole kitchen fully barricaded by a safety gate. LPA observed the fireplace in the family room to be screened. Safe and age appropriate toys, play equipment and materials were observed. LPA observed multiple smoke detectors and carbon monoxide detector, but unable to test due to day care children were sleeping at the time of the inspection. LPA reminded licensee, carbon monoxide, and smoke detector shall be in operable condition at all times. Fire Extinguisher (2A10BC) is in operable condition. Per Licensee no one smokes in the home. Electrical outlets are inaccessible, no baby bouncers saucer chairs, or any recalled and or prohibited toys or sleep/ play equipment were observed on the premises. There is a designated area for ill children as necessary in bedroom #2. Per Licensee there are no weapon/firearms in the home. The facility sketch is complete and current, there is working telephone (cell).
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE: DATE: 05/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/04/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: VARDONOVA, MARINA FAMILY CHILD CARE
FACILITY NUMBER: 197700177
VISIT DATE: 05/04/2023
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Last Fire/Disaster Drill complete and maintained current. Last Fire/Disaster Drill completed on 12/29/2022.

Roster complete and maintained current.

Bathroom: Shower/tub are free of hazards (child care bathroom). LPA did not observe any hazardous items in the children's bathroom. Toilet and faucet are clean and operable.

Kitchen: Sharp utensils, open bottles or alcohol are inaccessible. If food is brought from the children’s home, the container shall be labeled with the child’s name and properly stored or refrigerated. The home has a clean and fully stocked refrigerator/freezer. Breakfast, lunch, and snacks are provided. Licensee currently has a food program. Naps are provided in bedrooms #1-2.

Outdoor: The backyard is safe for children. The backyard is completely fenced (with block cement). There is no body of water. LPA observed age appropriate toys. Per licensee, no pets on the premises. LPA observed the outdoor air conditioner to be fully barricaded on the side of the home.

Advisory/Other: First Aid kit was observed with supplies readily available. CPR/First Aid expire 02/15/2024. Mandated Reporter expires 10/06/2023. There are no window cords accessible to children.
SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME: VARDONOVA, MARINA FAMILY CHILD CARE
FACILITY NUMBER: 197700177
VISIT DATE: 05/04/2023
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Documents Provided and or Discussed: Fire Drill Log, Roster, Postings, Safe Sleep PIN 20-24-CCP and Individual Sleeping Plan (LIC9227). Licensee stated currently does not have child care insurance.

Licensee Vardonova was reminded that all adults 18 and over living or working in the home, including employees and volunteers, must obtain a criminal record clearance or exemption, or transfer their existing clearance or exemption, prior to initial presence in a licensed Family Child Care Home. A civil penalty of $100.00 minimum/day up to $500.00 maximum per day/per person will be assessed if this regulation is violated.

LPA discussed the safe sleep regulations with licensee Vardonova and discussed the Child Care Licensing Safe Sleep webpage at https://www.cdss.ca.gov/inforesources/child-care-licensing/public-information-and-resources/safe-sleep as an additional resource. LPA also informed licensee of the importance of checking for recalled infant devices on the United States Consumer Product Safety Commission (CPSC) website at https://www.cpsc.gov/ and recommended they register all infant devices with the CPSC to be notified of any recalls on their purchased equipment.

No deficiencies cited at this time.

A notice of site visit was given to licensee and must remain posted for 30 days.

Failure to comply with posting requirements shall result in an immediate civil penalty of $100.

Exit interview conducted and report was reviewed with the licensee Marina Vardonova, along with her appeal rights and Notice of Site Visit.

SUPERVISORS NAME: Mariela Ramon
LICENSING EVALUATOR NAME: Justeene Tamayo
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2023
LIC809 (FAS) - (06/04)
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